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Urinary hyaluronic acid: a versatile marker of bladder cancer

  • Urology - Original Paper
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Abstract

Purpose

To evaluate the role of urinary hyaluronic acid (HA) as a diagnostic marker in urothelial carcinoma (UCC), squamous cell carcinoma (SCC), and adenocarcinoma (ADC) of urinary bladder and compare it with urine cytology.

Methods

HA was estimated in 170 subjects divided into three groups. Group I: UCC 88 patients, 28 with SCC and 12 with ADC; group II: 34 patients with benign bladder tumors; and group III: 10 healthy bladders. HA was estimated in urine and then readjusted to creatinine (HA/Cr) and protein (HA/Pr) in urine. Urine cytology was evaluated.

Results

The mean ± SD level HA was higher in UCC (589 ± 72), SCC (637 ± 45), and ADC (526 ± 30) as compared with benign (476 ± 92) and normal (277 ± 44) groups regardless the grade of tumor (p < 0.0001). A cutoff value of 490 ng/ml was calculated to detect malignancy with sensitivity of 98% and specificity of 66%. PPV, NPV, and ACC were 88.6%, 94.1%, and 90%, respectively. Urine cytology showed sensitivity of, specificity, PPV, NPV, and ACC of 52.6%, 90%, 90.45, 50%, and 65.5%, respectively. HA/Pr and HA/Cr, cutoff values for detection of malignancy were 84.9 and 9.6 but with less predictive values. Histopathological type was the only independent factor affecting level of HA on multivariate analysis, (p = 0.012, Exp (B) 14.98, 95% CI 1.8–121).

Conclusion

Combination of urinary HA and urine cytology provides reliable marker of bladder cancer.

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Abbreviations

BCa:

Bladder cancer

UCC:

Urothelial carcinoma

SCC:

Squamous cell carcinoma

ADC:

Adenocarcinoma

HA:

Hyaluronic acid

HA/Pr:

Hyaluronic acid adjusted to protein

HA/Cr:

Hyaluronic acid adjusted to creatinine

PPV:

Positive predictive value

NPV:

Negative predictive value

ACC:

Over all accuracy

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Authors and Affiliations

  1. Department of Urology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ahmad Sobhy El-Hefnawy & Ahmed A. Shokeir

  2. Department of Clinical Pathology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ehsan Mohamed Abd El Aty Rizk, Nabila Maher Al Demerdash Khamis & Mohammed Ali Atwa Barakat

  3. Department of Histopathology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Sherry M. Khater

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  1. Ahmad Sobhy El-Hefnawy
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Correspondence to Ahmad Sobhy El-Hefnawy.

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12077919/2014. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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El-Hefnawy, A.S., Rizk, E.M.A.E.A., Al Demerdash Khamis, N.M. et al. Urinary hyaluronic acid: a versatile marker of bladder cancer. Int Urol Nephrol 52, 1691–1699 (2020). https://doi.org/10.1007/s11255-020-02480-4

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